Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2017; 23(37): 6907-6910
Published online Oct 7, 2017. doi: 10.3748/wjg.v23.i37.6907
Persistent severe hypomagnesemia caused by proton pump inhibitor resolved after laparoscopic fundoplication
Synne Semb, Frederik Helgstrand, Flemming Hjørne, Peter Bytzer
Synne Semb, Peter Bytzer, Department of Gastroenterology, Zealand University Hospital, 4600 Køge, Denmark
Frederik Helgstrand, Flemming Hjørne, Department of Surgery, Zealand University Hospital, 4600 Køge, Denmark
Frederik Helgstrand, Peter Bytzer, Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark
Author contributions: Semb S drafted the manuscript; Helgstrand F, Hjørne F, Bytzer P revised the manuscript.
Informed consent statement: The patient has given (verbal) informed consent prior to publication.
Conflict-of-interest statement: None to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Synne Semb, MD, Department of Medicine, Division of Gastroenterology and Hepatology, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark.
Telephone: +45-23-328029 Fax: +45-56-631562
Received: February 24, 2017
Peer-review started: February 27, 2017
First decision: April 21, 2017
Revised: May 12, 2017
Accepted: July 12, 2017
Article in press: July 12, 2017
Published online: October 7, 2017

Magnesium deficiency can cause a variety of symptoms, including potentially life-threatening complications such as seizures, cardiac arrhythmias and secondary electrolyte disturbances. Hypomagnesemia can be a serious adverse effect to proton pump inhibitor (PPI) therapy, which is worrying due to the widespread use of PPIs. Current evidence suggest that the mechanism of PPI induced hypomagnesemia is impaired intestinal magnesium absorption. In this report, we present the case of a long-term PPI user with persistent hypomagnesemia with severe symptoms at presentation. He was unable to stop PPI treatment because of severe reflux symptoms, and was dependent on weekly intravenous magnesium infusions, until his magnesium levels finally normalized without the need for supplementation after a successful laparoscopic fundoplication.

Keywords: Hypomagnesemia, Proton pump inhibitor, Gastroesophageal reflux disease, Drug adverse effect, Laparoscopic fundoplication

Core tip: This case illustrates a long-term proton pump inhibitor (PPI) user with persistent hypomagnesaemia causing severe symptoms at presentation. For years, he was dependent on oral and later intravenous magnesium supplementation, until his hypomagnesemia rapidly improved upon PPI discontinuation. He was, however, not able to cope with the resulting reflux symptoms, and was not able to completely stop PPI treatment until he underwent a successful laparoscopic fundoplication.